Severe Neurologic Complications of SARS-CoV-2

Abstract

Purpose of review: This review presents an overview of the known neurocritical care complications of severe acute respiratory virus 2 (SARS-CoV-2). We present readers with a review of the literature of severe neurologic complications of SARS-CoV-2 and cases from our institution to illustrate these conditions.

Recent findings: Neurologic manifestations are being increasingly recognized in the literature. Some patients can have severe neurologic manifestations, though the true prevalence is unknown.

Summary: Severe neurologic complications of COVID-19 include large vessel occlusion ischemic stroke, intracranial hemorrhage, encephalitis, myelitis, Guillain-Barre syndrome, status epilepticus, posterior reversible encephalopathy syndrome, and hypoxic-ischemic encephalopathy. These conditions can manifest in COVID-19 patients even in the absence of risk factors and must be promptly identified as they can have a high mortality if left untreated.

Keywords: COVID-19 related stroke; Neurological complications of COVID-19; Seizure.

Fig. 1

Acute ischemic stroke. a Chest X-ray on admission with bilateral airspace opacities; b Isotropic MRI sequence demonstrating a right posterior cerebral artery ischemic stroke; c CT head performed 1 week following MRI of the brain demonstrating the evolving hypodensity within the right PCA territory associated with sulcal effacement and mass effect on the temporal horn of the right lateral ventricle.

Fig. 2

Hypoxic-ischemic encephalopathy. a Rapid response limited 8-channel EEG showing LPDs most prominent in the T5-O1 channel (4–5); b and c MRI with confluent areas of predominantly subcortical FLAIR hyperintensity (b) and restricted diffusion (c).